Abuela

The abuela was a standard admission of my internal medicine rotation. "CVA" said the medical record, which meant this Guatemalan grandmother, or abuela, had suffered a stroke. She was visiting the U.S. to help care for her first grandchild, who was due any day. She had felt fine until, suddenly, her diabetes, high blood pressure, and high cholesterol had imploded. In quick succession, she'd experienced a stroke, a 911 call, and the ER. Uninsured and undocumented, she'd been stabilized and transferred, serendipitously, to our nationally renowned rehab hospital--a stroke (no pun intended) of luck for this far-from-home 54-year-old.

I entered her room armed with my broken medical Spanish; it had gotten frequent use here in Los Angeles, but even so hadn’t progressed beyond basic symptoms and the present tense. I got along without an interpreter, however; my earnest efforts amused my patients and often revealed that many supposedly Spanish-only patients understood more English than they let on.

What I didn’t anticipate was the note over Abuela's bed: "Hearing Impaired." The nurse explained that Abuela didn’t sign, only read lips--en Español--and was also illiterate, meaning there would be no falling back on my much better written Spanish. I couldn’t even introduce myself to her clearly, as my garbled pronunciation made for terrible lip-Spanish.

How could I, the student admitting this patient on behalf of the attending physician, ever identify and address her medical issues if we couldn't effectively communicate? How could I help her understand the medications, consultations, tests, and procedures she'd receive, not to mention the grueling regimen of daily physical therapy, occupational therapy, speech and swallowing therapy, counseling psychology, and social work sessions? This program had so far ensured a successful, functional discharge for all the patients I'd seen, regardless of their disability on admission.

But the communication challenge, though exasperating for both of us, proved as surmountable as my patients' challenges. Between pictures, pointing, charades, gestures, and, occasionally, Abuela's daughter translating my broken Spanish into authentic lip-Spanish, we managed to connect. The chicken tamales Abuela made as her final occupational therapy assignment, while seated in a wheelchair, one-handed, with limited vision, were a delicious testament to her perseverance, to her love for family, to team-based care.

I’ll never forget the day I hugged Abuela good-bye, over her tightly swaddled new grandbaby, as she left the hospital. That was the day I decided I never wanted to leave such work.